Perspectives on Care Coordination for Youth with TBI: Moving Forward to Provide Better Care

BACKGROUND: Care coordination aligns services and optimizes outcomes for children with traumatic brain injury (TBI), yet numerous obstacles can impede effective care coordination following a TBI. OBJECTIVE: The goal of this work is to identify barriers and facilitators to care coordination from the perspective of individuals who care for young people impacted by TBI. METHODS: Twenty-one care providers participated in semi-structured interviews to gather their perspectives on systems of care coordination for youth with TBI and potential areas for improvement. Using reflexive thematic analysis, researchers identified key themes across interviews. RESULTS: Three themes were identified: 1) gaps in knowledge; 2) poor collaboration and communication between systems and care providers; and 3) inadequate legislative and policy frameworks that fund and support pediatric TBI. Across themes, participants shared their experiences and ideas to improve each of these areas. CONCLUSIONS: A structured, consistent, and coordinated system of care for pediatric TBI is critical to ensure optimal outcomes. Protocols that emphasize intentional and productive collaboration between healthcare settings and schools and education for all care providers are cornerstones in improving outcomes for children. Top-down action that develops policy and funding initiatives is needed to ensure equitable, consistent access to appropriate healthcare and educational supports

Care Coordination for Children with Special Health Care Needs: A Scoping Review to Inform Strategies for Students with Traumatic Brain Injuries

BACKGROUND: Chronic and complex medical issues, including traumatic brain injuries (TBIs), have significant educational implications. The purpose of this study was to identify and summarize the literature on care coordination strategies among health care professionals, educators, and caregivers for children with special health care needs (CSHCN). Clarifying factors that influence care coordination for CSHCN can inform future studies on care coordination for students with TBI. Improved understanding of these factors may lead to better communication, reduction of unmet needs, more efficient service access, and improved long-term outcomes for children. METHODS A scoping review was conducted, guided by PRISMA-ScR methodology. Five databases (CINAHL, PSYCINFO, EMBASE, ERIC, PubMed) were searched to identify relevant studies that focused on care coordination and educational settings. RESULTS Twelve articles met inclusion criteria. Care coordination interventions for CSHCN used in educational settings focused on relationship-building strategies, clear procedures and roles, and education of members of the school community. CONCLUSIONS Findings highlight strategies to coordinate care for CSHCN and factors that may moderate effects of these interventions. Key stakeholders should now study these strategies specifically in children with TBI

A scoping review to inform care coordination strategies for youth with traumatic brain injuries: Care coordination tools

BACKGROUND: Children with traumatic brain injury (TBI) report unmet needs several years after their injury and may require long-term care. However, this chronic health condition is often only treated and monitored in the short-term. Care for young persons with TBI often relies on parents to manage their child’s complex care network. Effective care coordination can close these gaps and facilitate continuity of care for children with TBI. The purpose of this scoping review was to develop a better understanding of tools that improve care coordination for Children with Special Health Care Needs (CSHCN). This, in turn, can inform care for children with TBI. METHODS: A scoping review was conducted following the PRISMA framework and methodology. OVID/Medline, CINAHL, PsycINFO, EMBASE, and ERIC databases were searched for articles relevant to care coordination tools used with CSHCN. RESULTS: 21 articles met the criteria for inclusion in the review, and 6 major categories of care coordination tools were identified: telehealth, online health records and tools, care plans, inpatient discharge protocols, family training, and reminders. DISCUSSION: Studies examining telehealth, online tools, care plans, and family training care coordination interventions for CSHCN have shown positive outcomes and would be relevant strategies to improve the care of children with TBI. Future prospective research should investigate these tools to explore whether they might improve communication, reduce unmet needs, increase service access, and improve long-term outcomes for children with TBI

A scoping review to inform care coordination strategies for youth with traumatic brain injuries: Care coordination personnel

Introduction & Importance: Effective, patient-centered care coordination has been shown to improve outcomes for children with special healthcare needs (CSHCN), who often have complex, long-term involvement with multiple service providers. Traumatic brain injury (TBI) can result in long-term physical, intellectual, social, and emotional disabilities that persist long after acute treatment. Yet, even though it is a chronic condition, TBI remains an area with scarce standardization and research surrounding the complex, long-term care coordination need in this population. The purpose of this scoping review is to summarize current research on outcomes in CSHCN after implementation of care coordinators, whether individual or teams, to inform future research for youth with TBI. Methods: OVID/Medline, CINAHL, PsycINFO, EMBASE, and ERIC databases were searched for articles relevant to care coordination and CSHCN. Results: 31 articles met inclusion criteria. Outcomes for children and families were grouped into 5 major categories: healthcare utilization, cost of care, disease status, parent and child quality of life, and healthcare satisfaction and perception of care. Discussion: Implementation of care coordinators, whether in the form of individuals, dyads, or teams, resulted in overall positive outcomes for CSHCN and their families across all 5 major outcome domains. Future research should be focused on the efficacy of care coordinators differing in profession, qualifications, and educational attainment specifically for the unique needs of children with TBI. Additionally, the application of care coordination within medical homes should be further investigated to increase proactive, preventative care of children with TBI and further reduce reactive, need-based treatment only

Brain Injury Is Treatable

Children with traumatic brain injury (TBI) are under-identified and under-served by healthcare and educational professionals. Factors such as lack of understanding regarding long-term needs following TBI, limited awareness and training in emerging evidence-based practices and inefficient care coordination (Haarbauer-Krupa et al., 2017) impede effective clinical management. Despite these considerable challenges, childhood brain injury is treatable. Families, schools, and healthcare systems are integral to that treatment. Where a child lives and learns can also greatly influence long-term outcomes. Children from home environments with supportive caregivers have more positive outcomes (Wade et al., 2016). Closer proximity to medical care and providers who streamline postacute care, rehabilitation, and community services also positively affect recovery (Buzza et al., 2011). Schools with educators who are trained to understand the unique needs of students with TBI are better situated to ensure that needed services and accommodations are received upon a child’s return to school (Davies, 2016)

Adolescent discourse summarization (Lundine et al., 2018)

<div><b>Purpose:</b> Summarizing expository passages is a critical academic skill that is understudied in language research. The purpose of this study was to compare the quality of verbal summaries produced by adolescents for 3 different discourse types and to determine whether a composite measure of cognitive skill or a test of expressive syntax predicted their performance.</div><div><b>Method:</b> Fifty adolescents listened to, and then verbally summarized, 1 narrative and 2 expository lectures (compare–contrast and cause–effect). They also participated in testing that targeted expressive syntax and 5 cognitive subdomains.</div><div><b>Results:</b> Summary quality scores were significantly different across discourse types, with a medium effect size. Analyse revealed significantly higher summary quality scores for cause–effect than compare–contrast summaries. Although the composite cognitive measure contributed significantly to the prediction of quality scores for both types of expository summaries, the expressive syntax score only contributed significantly to the quality scores for narrative summaries.</div><div><b>Conclusions:</b> These results support previous research indicating that type of expository discourse may impact student performance. These results also show, for the first time, that cognition may play a predictive role in determining summary quality for expository but not narrative passages in this population. In addition, despite the more complex syntax commonly associated with exposition versus narratives, an expressive syntax score was only predictive of performance on narrative summaries. These findings provide new information, questions, and directions for future research for those who study academic discourse and for professionals who must identify and manage the problems of students struggling with different types of academic discourse.</div><div><br></div><div><b>Supplemental Material S1.</b> Descriptive block-level U.S. Census values for participants and rotated structure matrix for principal component analysis with Varimax rotation of socioeconomic status (SES) variables.</div><div><br></div><div><b>Supplemental Material S2.</b> Descriptions of compare–contrast, cause–effect, and narrative lectures. </div><div><br></div><div><b>Supplemental Material S3.</b> Tests used from the National Institutes of Health Toolbox Cognition Battery.</div><div><br></div><div><b>Supplemental Material S4.</b> Pearson correlations for Expressive Syntax score, MLCU, and SI for compare–contrast, cause–effect, and narrative summaries (<i>N</i> = 50).</div><div><br></div><div><b>Supplemental Material S5.</b> Pearson correlations for total summarization quality scores for compare–contrast, cause–effect, and narrative lectures, age, socioeconomic status (SES) factors, cognitive composite score, and expressive syntax score (<i>N</i> = 48).</div><div><br></div><div>Lundine, J. P., Harnish, S. M., McCauley, R. J., Blackett, D. S., Zezinka, A., Chen, W., & Fox, R. A. (2018). Adolescent summaries of narrative and expository discourse: Differences and predictors. <i>Language, Speech, and Hearing Services in Schools, 49, </i>551–568. https://doi.org/10.1044/2018_LSHSS-17-0105</div